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Percutaneous interventional procedures in the patient with lower extremity claudication

Julie M Zaetta, MD
Richard A Baum, MD
Section Editors
Donald Cutlip, MD
Denis L Clement, MD, PhD
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS


Intermittent claudication, defined as a reproducible discomfort of a defined group of muscles that is induced by exercise and relieved with rest, is generally a reliable indicator of peripheral artery disease [1,2]. Most patients with intermittent claudication remain stable with medical therapy. When revascularization is indicated, the options are percutaneous interventional procedures and surgical bypass.

The general indications for revascularization in patients with claudication, and the indications for and outcomes of percutaneous intervention, will be reviewed here. The roles of medical therapy and surgical revascularization for intermittent claudication are discussed elsewhere. (See "Management of claudication" and "Surgical management of claudication".)


The location of lower extremity pain varies depending on which vessels are involved. The severity of symptoms depends upon the location and degree of stenosis, the collateral circulation, and the vigor of exercise. Claudication of the buttock, hip, or thigh is generally an indication of proximal occlusive disease. Although femoropopliteal occlusive disease is more likely the source of calf claudication, some patients with iliac artery stenosis can have calf claudication as their primary symptom rather than thigh claudication. (See "Clinical features and diagnosis of lower extremity peripheral artery disease", section on 'Claudication'.)

TASC classification — The guideline from the Inter-Society Consensus for the Management of Peripheral Artery Diseases (TASC II) presents a scheme that classifies iliac, femoral, and popliteal lesions as type A, B, C, or D based upon overall success rates of treating the lesion using endovascular or surgical means [3]. There are no classifications referable to the tibial vessels. In general, short segments of disease are more likely to be successfully treated with an endovascular intervention compared with long segments of occlusion. The details of the TASC classification are reviewed in detail elsewhere. (See "Classification of lower extremity peripheral artery disease", section on 'TASC classification'.)

Lesions amenable to percutaneous intervention — In general, endovascular therapy is the treatment of choice for TASC type A lesions, and endovascular treatment is preferred over surgical treatment for type B lesions [3]. Patients with type C lesions who are not good risk candidates for surgery may also benefit from percutaneous intervention. The patient's comorbidities, fully informed patient preference, and the operator's long-term success rates must be considered when making treatment recommendations for type B and type C lesions.

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Literature review current through: Nov 2017. | This topic last updated: Nov 14, 2017.
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